Provider Demographics
NPI:1043414980
Name:THE CLINICAL EVALUATION AND RESOURCE CENTER, PLLC
Entity Type:Organization
Organization Name:THE CLINICAL EVALUATION AND RESOURCE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAMILLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPA
Authorized Official - Phone:252-430-1255
Mailing Address - Street 1:943 W ANDREWS AVE STE P
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2587
Mailing Address - Country:US
Mailing Address - Phone:252-430-1255
Mailing Address - Fax:
Practice Address - Street 1:943 W ANDREWS AVE STE P
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2587
Practice Address - Country:US
Practice Address - Phone:252-430-1255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1956103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005867Medicaid